Harrison's Manual of Medicine
INFECTIONS IN CANCER PTS
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Table 82-1 lists the normal barriers to infection whose disruption may permit infections in immunocompromised pts, with particular relevance for the noted cancers. Infection-associated mortality rates among cancer pts have decreased as a result of an evolving approach entailing early use of empirical broad-spectrum antibiotics; empirical antifungal therapy in neutropenic pts who, after 4–7 days of antibiotic treatment, remain febrile without positive cultures; and use of antibiotics for afebrile neutropenic pts as broad-spectrum prophylaxis against infections.
| TYPE OF DEFENSE | SPECIFIC LESION | CELLS INVOLVED | ORGANISM | CANCER ASSOCIATION | DISEASE |
|---|---|---|---|---|---|
| Physical barrier | Breaks in skin | Skin epithelial cells | Staphylococci, streptococci | Head and neck, squamous cell carcinoma | Cellulitis, extensive skin infection |
| Emptying of fluid collections | Occlusion of orifices: ureters, bile duct, colon | Luminal epithelial cells | Gram-negative bacilli | Renal, ovarian, biliary tree, metastatic diseases of many cancers | Rapid, overwhelming bacteremia; urinary tract infection |
| Lymphatic function | Node dissection | Lymph nodes | Staphylococci, streptococci | Breast cancer surgery | Cellulitis |
| Splenic clearance of microorganisms | Splenectomy | Splenic reticuloendothelial cells | Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Babesia, Capnocytophaga canimorsus | Hodgkin’s disease, leukemia | Rapid, overwhelming sepsis |
| Phagocytosis | Lack of granulocytes | Granulocytes (neutrophils) | Staphylococci, streptococci, enteric organisms, fungi | Acute myeloid and acute lymphocytic leukemias, hairy cell leukemia | Bacteremia |
| Humoral immunity | Lack of antibody | B cells | S. pneumoniae, H. influenzae, N. meningitidis | Chronic lymphocytic leukemia, multiple myeloma | Infections with encapsulated organisms, sinusitis, pneumonia |
| Cellular immunity | Lack of T cells | T cells and macrophages | Mycobacterium tuberculosis, Listeria, herpesviruses, fungi, intracellular parasites | Hodgkin’s disease, leukemia, T cell lymphoma | Infections with intracellular bacteria, fungi, parasites; virus reactivation |
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Table 82-1 lists the normal barriers to infection whose disruption may permit infections in immunocompromised pts, with particular relevance for the noted cancers. Infection-associated mortality rates among cancer pts have decreased as a result of an evolving approach entailing early use of empirical broad-spectrum antibiotics; empirical antifungal therapy in neutropenic pts who, after 4–7 days of antibiotic treatment, remain febrile without positive cultures; and use of antibiotics for afebrile neutropenic pts as broad-spectrum prophylaxis against infections.
| TYPE OF DEFENSE | SPECIFIC LESION | CELLS INVOLVED | ORGANISM | CANCER ASSOCIATION | DISEASE |
|---|---|---|---|---|---|
| Physical barrier | Breaks in skin | Skin epithelial cells | Staphylococci, streptococci | Head and neck, squamous cell carcinoma | Cellulitis, extensive skin infection |
| Emptying of fluid collections | Occlusion of orifices: ureters, bile duct, colon | Luminal epithelial cells | Gram-negative bacilli | Renal, ovarian, biliary tree, metastatic diseases of many cancers | Rapid, overwhelming bacteremia; urinary tract infection |
| Lymphatic function | Node dissection | Lymph nodes | Staphylococci, streptococci | Breast cancer surgery | Cellulitis |
| Splenic clearance of microorganisms | Splenectomy | Splenic reticuloendothelial cells | Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Babesia, Capnocytophaga canimorsus | Hodgkin’s disease, leukemia | Rapid, overwhelming sepsis |
| Phagocytosis | Lack of granulocytes | Granulocytes (neutrophils) | Staphylococci, streptococci, enteric organisms, fungi | Acute myeloid and acute lymphocytic leukemias, hairy cell leukemia | Bacteremia |
| Humoral immunity | Lack of antibody | B cells | S. pneumoniae, H. influenzae, N. meningitidis | Chronic lymphocytic leukemia, multiple myeloma | Infections with encapsulated organisms, sinusitis, pneumonia |
| Cellular immunity | Lack of T cells | T cells and macrophages | Mycobacterium tuberculosis, Listeria, herpesviruses, fungi, intracellular parasites | Hodgkin’s disease, leukemia, T cell lymphoma | Infections with intracellular bacteria, fungi, parasites; virus reactivation |
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